Usefulness of computed tomography textural analysis in renal cell carcinoma nuclear grading

Purpose: To evaluate the usefulness of computed tomography (CT) texture descriptors integrated with machine-learning (ML) models in the identification of clear cell renal cell carcinoma (ccRCC) and for the first time papillary renal cell carcinoma (pRCC) tumor nuclear grades [World Health Organization (WHO)/International Society of Urologic Pathologists (ISUP) 1, 2, 3, and 4]. Approach: A total of 143 ccRCC and 21 pRCC patients were analyzed in this study. Texture features were extracted from late arterial phase CT images. A complete separation of training/validation and testing subsets from the beginning to the end of the pipeline was adopted. Feature dimension was reduced by collinearity analysis and Gini impurity-based feature selection. The synthetic minority over-sampling technique was employed for imbalanced datasets. The ML classifiers were logistic regression, SVM, RF, multi-layer perceptron, and $$ -NN. The differentiation between low grades/ high grades, grade 1/grade 2, grade 3/grade 4, and between all grades was assessed for ccRCC and pRCC datasets. The classification performance was assessed and compared by certain metrics. Results: Textures-based classifiers were able to efficiently identify ccRCC and pRCC grades. An accuracy and area under the characteristic operating curve (AUC) up to 91%/0.9, 91%/0.9, 90%/0.9, and 88%/1 were reached when discriminating ccRCC low grades/ high grades, grade 1/grade 2, grade 3/grade 4, and all grades, respectively. An accuracy and AUC up to 96%/1, 81%/0.8, 86%/0.9, and 88%/0.9 were found when differentiating pRCC low grades/ high grades, grade 1/grade 2, grade 3/grade 4, and all grades, respectively. Conclusion: CT texture-based ML models can be used to assist radiologist in predicting the WHO/ISUP grade of ccRCC and pRCC pre-operatively.